Bottom Line:
Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth.Among the women in this cohort there were no cases of MTCT of HIV.There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.

Objective: To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV).

Study methods: A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed.

Results: Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV.

Conclusions: There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.

Mentions:
The median length of time of rupture of membranes for the entire cohort was 0.63 hours (0.00–77.87). The median length of time of rupture of membranes for the vaginal birth group was 2.56 hours (0.00–53.90) and cesarean birth group was 0.02 hours (0.00–77.87) (P < 0.0001). For those women with an undetectable VL, the median length of time of rupture of membranes was 0.62 hours (0.00–77.87) and for those with a detectable VL was 0.57 hours (0.00–33.63) (P > 0.92). When removing those who were ruptured less than 0.03 hours (elective cesareans, precipitous vaginal deliveries, etc.), there were 131 patients whose membranes were ruptured for 0.05 hours or longer. Their median length of time of rupture was 3.53 hours (0.05–77.87). In total, 59 (28%) women had rupture of membranes for 4 hours or longer. For women who were less than 37 weeks at the time of delivery, the median length of time of rupture was 0.63 hours (0.00–77.87), and 0.66 hours (0.00–53.90) for those greater than 37 weeks. The median lengths of time of rupture and gestational ages are shown in Figure 1.

Mentions:
The median length of time of rupture of membranes for the entire cohort was 0.63 hours (0.00–77.87). The median length of time of rupture of membranes for the vaginal birth group was 2.56 hours (0.00–53.90) and cesarean birth group was 0.02 hours (0.00–77.87) (P < 0.0001). For those women with an undetectable VL, the median length of time of rupture of membranes was 0.62 hours (0.00–77.87) and for those with a detectable VL was 0.57 hours (0.00–33.63) (P > 0.92). When removing those who were ruptured less than 0.03 hours (elective cesareans, precipitous vaginal deliveries, etc.), there were 131 patients whose membranes were ruptured for 0.05 hours or longer. Their median length of time of rupture was 3.53 hours (0.05–77.87). In total, 59 (28%) women had rupture of membranes for 4 hours or longer. For women who were less than 37 weeks at the time of delivery, the median length of time of rupture was 0.63 hours (0.00–77.87), and 0.66 hours (0.00–53.90) for those greater than 37 weeks. The median lengths of time of rupture and gestational ages are shown in Figure 1.

Bottom Line:
Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth.Among the women in this cohort there were no cases of MTCT of HIV.There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.

Objective: To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV).

Study methods: A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed.

Results: Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV.

Conclusions: There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.